Why nutrition matters for adolescent girls

Dimtu, SNNP Region, Ethiopia

By Demissew Bizuwerk
Arsemawit Koroto
UNICEF Ethiopia/2021/Mulugeta Ayene
22 March 2021

Arsemawit Koroto, 17, is leading a meeting of peers at the Bilaten Tena Secondary and Preparatory School.  Using a guidebook, the discussion touches on topics such as menstruation, hygiene, and nutritious food. Arsemawit chairs the school’s girls’ club which advocates for the rights of adolescent girls to services that enhance their wellbeing. She is also a member of the school’s health and nutrition club.  

“The adolescent life is more challenging for girls than boys,” she argues. “When girls are in puberty, especially when they start their menses, that is the time they need proper guidance.” 

Arsemawit Koroto
UNICEF Ethiopia/2021/Mulugeta Ayene
Arsemawit (r) and her friends in the girls’ club discuss issues relevant to their future.

Arsemawit says she suffers from fatigue and nausea when she is on her monthly cycle. 

“I feel tired and weak,” she says. “The cramps are painful and awful, and I can’t concentrate in class.”  

She adds that until last year, she had no idea the fatigue was caused by a lack of iron in her blood. In December 2020, months after the new academic year had started, a programme to distribute iron supplement tablets to schoolgirls aged between 10-19 years was initiated in her school. The initiative is implemented by the region health and education authorities with support from UNICEF.  

At first, members of the girls’ and nutrition clubs were oriented on the importance of iron in human nutrition and they in turn were expected to raise awareness among their peers.   

“When the iron supplements were brought to our school, many were reluctant to take them, fearing that it could be contraceptives,” says Azeb Abera, another member of the girls’ club.  

Arsemawit Koroto
UNICEF Ethiopia/2021/Mulugeta Ayene
Arsemawit, 17, takes iron supplement tablets in her school. “the supplement is helping me gain my strength,” she says.

Arsemawit and her friends then came up with an idea. They began holding weekend coffee sessions where they invited girls would speak freely about their fears. To show that they were safe, Arsemawit and her friends would take the tablets first.    

“It wasn’t easy to convince the girls but after they saw the benefits, many started taking the tablets,” adds Arsemawit. “I see how the supplements have helped me to regain my strength. I share my experience with girls in school and encourage them to take the tablets. The programme was actually running smoothly until the COVID pandemic affected everything”  

Despite being a normal biological function, menstruation faces many social, cultural and religious misconceptions and most girls in rural areas are unaware of and unprepared for their menarche. Because discussing it is taboo, menstruation and its impact on the health and learning of girls is often overlooked.  

Adolescent girls in marginalized communities are particularly vulnerable to malnutrition because of poor diets. They lack protein and other micronutrients to support their fast growth while their body demands more iron lost mainly during menstruation. 

  According to the World Health Organization, adolescence is marked by a rapid phase of growth and development during which the requirement of nutrition and micronutrients is relatively high. Girls at this age are particularly vulnerable to iron deficiency1 which leads to anemia.  

Arsemawit Koroto
UNICEF Ethiopia/2021/Mulugeta Ayene
UNICEF supports adolescent friendly health and friendly services including the distribution of iron supplements to adolescent girls in schools. The girls receive a tablet every week.

In Ethiopia, 56 per cent of children under the age of 5 and 23 per cent of women in reproductive age (15–49 years), suffer from anemia2, a condition in which the number of red blood cells or the hemoglobin concentration is lower than normal. Though iron deficiency could occur at any stage in life, it is most prevalent among children, adolescents and pregnant women. Due to a high growth spurt during adolescence, the need for iron will increase two-to-three-fold. In addition, menstruating girls lose between 12.5 to 15 mg of iron each month, making them more vulnerable to anemia, which could have irreversible impacts through their reproductive years and beyond. 

For this reason, UNICEF supports adolescent-friendly health services which include iron supplementation.  

“This is part of the wider support we are providing around adolescent development,” says Sinksar Simeneh, a nutrition specialist. “We focus mainly on girls from poor families so that they have access to services tailored to their unique needs.”  

Arsemawit and her friends are preparing for their semester exams. Their active involvement in school clubs not only helps them to be confident, but it also helps them to study together. The girls aim to join university after their grade 12 national exams next year. Before then, they intend to continue advocating for the rights of adolescent girls to health and nutrition.